In Defense of The Borg

May 19 will be my sixth anniversary as a Borg drone here at Southwest Hive.

I’m still not fully assimilated. Likely never will be.

I jokingly call my employer The Borg because of their tendency to gobble up smaller ambulance services on the fringes of their territory, relentlessly expanding their empire, like, well, The Borg. And they do have their own unique institutional culture here. They want you to buy in to their approach to EMS and customer service. In fact, they openly refer to it as “The _____ Way.” 

To be sure, a lot of drones have bought in. We’ve got plenty of people who “bleed green,” as they say, and for those people, if it’s not practiced at this company, it might as well not exist in their universe. They think “The _____ Way” is the only way.

Me, I know better. I’ve been around long enough to know shit from Shinola when I smell it. That said, the way they want me to do things is not fundamentally incompatible with my professional ethics.

I’ve worked at other large national ambulance companies – let’s just stick with the Star Trek metaphors and call them “the Ferengi” – where being a good employee and being a good paramedic were fundamentally incompatible.

When I came to work for The Borg, it was a matter of some concern among management types if I’d fit in. I’m a pretty outspoken guy, after all, with a pretty big bully pulpit. People wondered how I’d react when Borg policy ran contrary to the way I think EMS should be done.

It was much worry over nothing, really. I’ve always made it a point to avoid publicly criticizing my employer as long as I’m still cashing their paychecks. Likewise, as long as they pay my salary, I follow their policies. I don’t have to like them, or even pretend they make sense, but I do have to follow them.

That’s one reason I have no desire to be a supervisor drone. There’s a big difference between following a policy, and supporting it. As a supervisor, I’d have a duty to support and enforce those policies. To shirk that duty would make me a hypocrite, and a shitty supervisor, to boot.

Still, The Borg doesn’t really force assimilation down your throat. It is possible here to be a good employee and a good medic. That point was driven home last week in our protocol update class. Some of the changes are timely, some are overdue, and some don’t go far enough in my opinion. But for the most part, they’re positive changes.

And in that protocol class, it was emphasized at least a dozen times, “Use good clinical judgement, and document accordingly.”

As in, “If the protocol says do X, but you believe that is inappropriate due to Y, exercise good clinical judgement and document accordingly.”

That’s all that needs to be said, really. The Borg is far too large to ever be considered clinically progressive – it’s hard to be cutting edge when you have to supervise and QA 2000 medics instead of 20 – but they don’t tie your hands behind your back, either, because of that one critical phrase:

“Use good clinical judgement, and document accordingly.”

I’ve said before that the words shall and must should be purged from EMS protocols, and replaced with may and consider.

May and consider are the two words that empower clinical decision-making. They make your protocols a floor, not a ceiling. That’s been pretty much my MO ever since I became a Borg Drone, and rarely have I been called on the carpet for it. The few times I have, were mostly due to deficiencies in documentation, not questioning my treatment. If I had painted a clearer picture of the patient’s condition and my decision-making process, there wouldn’t have been a problem.

When you’re a new medic, or a mediocre one, you tend to regard your treatment protocols as Holy Writ, and your medical director as an angry and vengeful god, ready to punish you harshly for deviating from The Word.

Obviously, neither is true, although I’ve met a few medical directors who are genuine assholes. Your protocols are treatment guidelines, not suicide pacts, and your medical director is just a guy. He’s a guy with far more medical education and responsibility than you, but generally speaking, he’s on your side, and he expects you to make good decisions in applying the guidelines he wrote.

And if you deviate from them, the good medical directors generally don’t have a problem with it.

Provided, you know, you exercise good clinical judgement and document accordingly.